The title and first line, "My Beautiful Grandmother / died ugly," set the tone for contrasts that continue throughout the poem: health and illness, beauty and ugliness, youth and age, life and death, staying and leaving. The poem initially describes the grandmother as aged, ready to die, anorexic and in such pain that she required six years of morphine. The needles used to inject medication, which left her arms bruised "black and blue" are contrasted with her previous embroidery needles, which she had used to stitch "pink cornucopias / on square after square of white cotton."

The grandmother was ready to die for a long time, to a place and time apart--to the mountains and to her spirited youth, when she was "dashing" and her "mind was as quick / as the stitch of a sparrow's wing." The poem continues with the compression of time yet marking the effects of time: old love letters to the grandmother crumble "like stale bread" in the hands of the granddaughter. The poem concludes with a short stanza alluding to difficulties that the granddaughter experienced leaving the Georgia town where her "beautiful grandmother stayed."